MEDICARE: BALANCED PATHWAYS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1245917087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED PATHWAYS

Provider Business Mailing Address
First Line	:	1301 JUSTIN RD STE 201
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75077-2183
Country	:	US
Telephone Number	:	713-516-3849
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 S STEMMONS FWY STE 100
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-5351
Country	:	US
Telephone Number	:	713-516-3849
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN MUTHEGA
Credential	:
Telephone Number	:	171-351-6384

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	11/29/2023

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Directions to “BALANCED PATHWAYS ” Practice Location

Language	Start Address	Practice Location

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